Issn Print: 0265-0215

Publication Date: 2004/06/01


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Pulmonary immune effects of one-lung-ventilation in patients undergoing thoracic surgery: A-308

Th. Schilling; C. Huth; F. Bühling; T. Welte; M. Senturk; Th. Hachenberg

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Background and Goal of Study: Mechanical ventilation may induce intraalveolar immune reactions including increased numbers of leukocytes, increased alveolar protein concentrations and expression of pro-inflammatory cytokines. One-lung ventilation (OLV) during thoracic surgery may aggravate these effects in the ventilated lung. In this prospective study, pulmonary immunological parameters were analysed prior to and after OLV.
Materials and Methods: 15 patients undergoing elective open thoracic surgery were included. After intubation with a double lumen tube the patients were mechanically ventilated (Two-lung ventilation (TLV) VT = 10 ml/kg, f = 10-12 VT/min adjusted to normal arterial pCO2, FiO2 = 0.35). During OLV, VT was maintained at 10 ml/kg and FiO2 was increased to 1.0. Fiberoptic, bronchoscopic guided, bronchoalveolar lavage of the ventilated lung was performed before, immediately after OLV and 2 hours postoperatively. In the BAL fluid, numbers of cells, protein concentrations, pro-inflammatory (TNFα, IL8) and anti-inflammatory cytokines (IL10) were determined. Data were analysed by Friedman and post-hoc Wilcoxon test.
Results and Discussions: Intra-alveolar protein concentrations and cell numbers increased over time as well as pro-inflammatory cytokines (IL8, TNFα). IL10 decreased significantly
Conclusions: Our results indicate that OLV with VT = 10 ml/kg and FiO2 = 1.0 initiates an epithelial damage and pro-inflammatory response in the alveolar compartment of the ventilated lung. Lung protective ventilatory approaches may be used to reduce lung damage during OLV in thoracic surgical patients.
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